1043401821 NPI number — MR. MIHIR M PRADHAN M.D.

Table of content: MR. MIHIR M PRADHAN M.D. (NPI 1043401821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043401821 NPI number — MR. MIHIR M PRADHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRADHAN
Provider First Name:
MIHIR
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043401821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 TAYLOR ROAD
Provider Second Line Business Mailing Address:
SUITE 3380
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-3587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-213-6287
Provider Business Mailing Address Fax Number:
334-213-6288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 E SOUTH BLVD
Provider Second Line Business Practice Location Address:
BAPTIST MEDICAL CENTER SOUTH
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-286-2987
Provider Business Practice Location Address Fax Number:
334-286-3368
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD28297 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD.28297 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 630902090 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-98983 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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